Internal Knee Pain by A.Griguolo

Generality

Internal knee pain is a very common symptom, which may depend on various conditions.

The causes of internal knee pain include: knee osteoarthritis, medial collateral ligament injuries, medial meniscus injuries, rheumatoid arthritis, goose leg bursitis or anserine bursitis, syndrome of the mid-patellar plica and medial knee bruises.

Short anatomical reference of the knee

The knee is the important synovial joint of the human body, placed between the femur (superiorly), tibia (inferiorly) and patella (anteriorly).

Its anatomy is quite complex and includes:

The articular cartilage, which covers the lower surface of the femur, the inner side of the patella and the center of the upper surface of the tibia, protecting all these bones from mutual rubbing;

The synovial membrane, which covers the joint from the inside and produces synovial fluid, a fluid with a lubricating action for all the internal structures of the knee;
The collateral ligaments, the cruciate ligaments and the patellar tendon, which, all together, guarantee the stability of the joint and the right alignment between the femur and tibia;
The synovial bags, which are small synovial membrane pockets, filled with a lubricating liquid very similar to the synovial fluid;
The inner meniscus (or medial meniscus ) and the external meniscus (or lateral meniscus ), which are cartilage cushions with shock absorbing and anti-rubbing function, located on the sides of the upper surface of the tibia.

What is Internal Knee Pain?

" Internal knee pain " is the expression indicating the painful sensation felt on the part of the knee that looks at the knee of the other lower limb; in other words, it is the way to define the pain suffered on the portion of the knee closest to the other knee, if one obviously imagines to observe a human body with the lower limbs extended and close to each other.

Internal Knee Pain means Pain in the Medial Portion of the Knee

"Internal knee" is the slang terminology for defining the medial portion of the knee .

Thus, internal knee pain is, in specialized language, pain in the medial portion of the knee.

In anatomy, the word "medial" is synonymous with proximity to the sagittal plane, ie the anteroposterior axis which symmetrically separates the human body into two parts, giving rise to a right half and a left half .

What Medical Figure is Internal Knee Pain?

The causes of internal knee pain are a matter for orthopedic doctors, or doctors specialized in the diagnosis, treatment and prevention of diseases that can affect the musculoskeletal system.

Who suffers the most from Internal Knee Pain?

Internal knee pain is a common symptom, which can affect people of all ages and has a higher incidence among sportsmen and generally very active individuals.

Causes

Internal knee pain is a symptom that, in adults and the elderly, has the most common causes:

Knee arthrosis ;
Medial collateral ligament injuries ;
Injuries to the medial meniscus ;
Rheumatoid arthritis ;
The so-called goose bursitis or anserine bursitis ;
The so-called middle patellar plica syndrome ;
Bruises in the medial knee without damage to the joint components.

Knee arthrosis

Osteoarthritis of the knee is the chronic inflammation of the knee, which results from the degeneration of the articular cartilage present on the femur and / or of the cartilage of the menisci present on the tibia.

Arthrosis of the knee is, unfortunately, an irreversible and progressive condition ; it produces, in fact, injuries to the cartilages of the knee that are impossible to recover and with the tendency to worsen over time.

In the medical field, knee osteoarthritis is also known as knee gonarthrosis or osteoarthritis .

Did you know that ...

Osteoarthritis is a form of arthritis (inflammation of the joints); to be precise, it is a form of " wear " arthritis of the articular cartilages.

Of the many forms of existing arthritis, osteoarthritis is the most widespread: it affects only 27 million people in the United States!

Injuries to the medial collateral ligament

The medial collateral ligament, or internal collateral ligament, is the knee ligament located on the inner side of the joint, originating from the so-called medial epicondyle of the femur and ending in the so-called medial condyle of the tibia .

In red, the medial collateral ligament (or internal).

Medial collateral ligament injuries consist of strains or, in the worst case, lacerations of the connective-fibrous tissue constituting the ligament in question.

As a rule, stretching and lacerations of the medial collateral ligament are the result of a distortion of the knee, following a sudden and abrupt trauma (bad fall, abnormal torsion, etc.).

People who play sports in which sudden changes of direction in the race and jumps (eg, football, rugby or basketball) and the elderly with walking problems are to suffer the most from injuries to the medial collateral ligament.

In medicine, the term " distortion " indicates an injury to the musculoskeletal system, which is characterized by a temporary alteration of the anatomical relationships within a joint and the consequent damage, more or less profound, to one or more components joint.

Injuries to the medial meniscus

The medial meniscus, or internal meniscus, is the layer of fibrous cartilage in the shape of a crescent (or of C), which takes place on the medial portion of the upper surface of the tibia and which serves, mainly, to absorb the knocks against the joint .

The medial meniscus injuries consist of lesions, lacerations and fissures of the fibrous cartilage constituting the internal meniscus.

In most cases, injuries to the medial meniscus are the result of a distortion of the knee, following an abrupt and sudden traumatic event; more rarely, they result from repeated improper stresses of the joint, which, in the long run, are harmful to the internal meniscus.

Did you know that ...

There are various types of lesion of the medial meniscus; Among the most common types of lesion of the medial meniscus include: the radial lesion, the flap lesion, the "bucket handle" lesion, the longitudinal lesion and the degenerative lesion.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory disease of the synovial joints, whose main target is the synovial membrane and which, over time, determines the alteration of the joint capsule, ligaments and articular cartilage.

Rheumatoid arthritis is a medical condition that originates from a malfunction of the immune system; this is the reason for its inclusion in the list of autoimmune diseases.

The exact cause that alters the functions of the immune system and determines rheumatoid arthritis is uncertain; however, it is a fact that factors such as: belonging to the female, age over 40, cigarette smoking and being in contact with some pathogens such as herpes virus or Epstein Barr virus.

Goose leg bursitis

In the medical field, the term " bursitis " indicates the inflammation of a synovial bursa, that is the inflammation of one of those synovial membrane sacs containing synovial fluid, which are among the characteristic elements of the synovial joints and which serve to reduce the friction between ligaments, tendons and joint cartilages.

The bite of the goose leg is the inflammation of the synovial bursa of the knee interposed between the medial collateral ligament and the so-called goose leg (or pes anserinus ), ie the medial prominence present on the proximal end of the tibia on which they are inserted the sartorius, gracile and semitendinosus muscles .

To cause the bite of the goose leg can be:

Traumas directed to the synovial bursa described above, such as to cause injury;
Excessive use of the knee joint;
The anomalous friction between the above described synovial bursa and one of the adjacent anatomical structures;
Poor stretching and poor flexibility of the hamstrings.

In the bite of the goose leg, the pain in the internal knee is the result of the compression that the synovial pouch, which is the protagonist of the condition in question, exercises on the adjacent articular structures, due to its inflammation and the consequent swelling.

Did you know that ...

Risk factors for goose leg bursitis include obesity, knee osteoarthritis and medial meniscus injuries.

Middle patellar plica syndrome

In medicine, the term " plica " referring to a synovial joint refers to one of the characteristic folds present on the synovial membrane .

The medial patellar plica syndrome is the irritation, followed by inflammation, of one of the typical folds present on the medial portion of the synovial membrane of the knee.

Generally, the middle patellar plica syndrome is related to an excessive use of the knee: to cause it, for example, may be the continuous repetition of a flexion movement.

Knee bruises in the medial area

Knee bruises in the medial area are injuries of the inner portion of the knee that do not compromise the integrity of the joint structures, but are nevertheless responsible for pain.

Generally, at the origin of the internal knee bruises there are falls or involuntary blows that directly affect the inner side of the joint.

Internal knee bruises are a minor clinical condition.

Causes of Internal Knee Pain in Young People

In young people, the most common causes of internal knee pain are slightly different from those reported for adults and the elderly.

Specifically, these causative factors are:

Patellar subluxation ;
Patellar tendonitis or patellar tendon ;
Tibial apophysitis or Osgood-Schlatter syndrome .

Symptoms and Complications

Internal knee pain almost always occurs in association with other symptoms ; the symptomatology associated with internal knee pain depends on the underlying cause and may include, as appropriate, manifestations such as:

Joint stiffness;
Reduced knee mobility;
Swelling at the knee;
Cracking or crackling emission from the knee, with each movement of the joint;
Redness and heat on the knee;
Unstable knee;
Formation of osteophytes within the joint (in the arthritis of the knee);
Atrophy of the thigh muscles.

Complications

If the cause is a clinically relevant condition such as knee osteoarthritis or if treatment of the triggering cause is inappropriate, internal knee pain can take on the characteristics of a chronic condition, which afflicts the patient even during the most trivial activities daily (eg: climbing stairs or entering or leaving the car).

When should I go to the doctor?

Internal knee pain is a symptom that should worry and induce the person concerned to consult a doctor when:

It has been running for several days;
Despite the rest and the application of ice, it persists and shows no signs of improvement;
It is the result of a knee sprain;
It is associated with several other symptoms (eg, joint stiffness, swelling, reduced joint mobility, etc.).

Diagnosis

When talking about the diagnosis of internal knee pain, the object of discussion is clearly the identification of the triggering cause, or the origin of the pain sensation.

Except for the clinically less severe cases (for which it is not always necessary to consult a doctor), research aimed at establishing the reasons for a worrying internal knee pain begins with an investigation relating to the associated symptoms and an accurate physical examination ; therefore, they continue with a thorough medical history ; finally, they end with imaging, to be precise with knee magnetic resonance .

Therapy

Many episodes of internal knee pain benefit from a conservative therapy that can be easily achieved in the home, based on:

Rest from all those activities that feed the painful sensation.
Generally, activities that are harmful to those suffering from internal knee pain are walking for long stretches, running, jumping, etc .;
Application of ice on the inside of the knee.
Ice has a pain-relieving and anti-inflammatory power, which many people underestimate.
Normally, in the presence of internal knee pain, doctors recommend applying ice 4-5 times a day, for at least 15-20 minutes;

Taking non-steroidal anti-inflammatory drugs ( NSAIDs ).
Thanks to their anti-inflammatory power, NSAIDs alleviate the painful sensation;
Application, around the knee, of a compressive elastic band .
The use of a compressive elastic band serves to mitigate any swelling and a possible sense of instability at the knee level;
Elevation of the lower limb .
Keeping the lower limb elevated reduces the blood supply to the knee; a lower blood supply to a suffering knee relieves pain and promotes the resolution of a possible swelling.

What to do if Conservative Therapy fails?

If the internal knee pain persists despite the aforementioned conservative therapy, the doctor will indicate treatments, slightly or significantly (depending on the circumstance), more invasive, including:

Localized injection of corticosteroids .
Corticosteroids are very effective anti-inflammatory drugs; however, because of their possible adverse effects, doctors use them only if strictly necessary;
The use of a knee brace as an element supporting the joint;
Physiotherapy .
Fundamental for when internal knee pain and associated symptoms are not affected by the benefits of rest, physiotherapy includes strengthening and stretching exercises for all the muscles of the ailing lower limb; in particular, the importance of strengthening the thigh muscles should be noted.
The drainage of excess fluid ( therapeutic arthrocentesis ).
It consists of introducing a special needle into the ailing knee (to be precise where it locates the swelling) and aspirating.
Often, at aspiration, the treating physician accompanies the injection an anti-inflammatory drug belonging to the category of corticosteroids and / or the injection of a hyaluronic acid.
Surgery .
It is the most invasive solution of all, even if - it is important to point it out - today the operating techniques are much less gory than in the past.
Surgery becomes the only way forward, when not only conservative treatments have been ineffective, but also those just mentioned (corticosteroids, knee brace, etc.).

How the Cause of Internal Knee Pain Affects Therapy

In the therapeutic management of internal knee pain, the cause of the pain is important, because:

It affects the duration of conservative therapy.
It affects the probability of success of conservative therapy.
It is the element on which the planning of a possible physiotherapy is based. Physiotherapy exercises vary depending on the cause of internal knee pain.
Similar to the previous case, it is the element on which the planning of a possible surgical intervention is based. For every cause of internal knee pain, there is ad hoc surgical treatment.

Prognosis

The prognosis in the presence of an internal knee pain depends on the cause of the pain; in fact, if the cause is clinically insignificant, internal knee pain resolves quickly; vice versa, if the cause is clinically important, the internal knee pain may disappear only after several weeks of treatment or, even in the presence of a condition such as knee osteoarthritis, never disappear completely.